374604675-12-5-2023-08-AS-LTEZ-CYXN8P-20231228091440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604675
Report Date: 12/05/2023
Date Signed: 12/05/2023 03:40:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/30/2023 and conducted by Evaluator Natasha Persaud

COMPLAINT CONTROL NUMBER: 08-AS-20231130145142

FACILITY NAME:	GROSSMONT GARDENS SENIOR LIVING		FACILITY NUMBER:	374604675
ADMINISTRATOR:	JONES, REGINALD		FACILITY TYPE:	740
ADDRESS:	5480 MARENGO AVE		TELEPHONE:	(619) 463-0281
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY:	425	CENSUS: 301	DATE:	12/05/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Executive Director, Reginald Jones		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Medications not given as prescibed

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced visit to commence a complaint investigation. LPA identified herself and discussed the allegation mentioned above with Assistant Administrator, Lane Hermosillo and Executive Director, Reginald Jones.

During today’s visit, the facility was briefly toured, records reviewed, and interviews with staff, resident, and outside sources. It was alleged medications were not given as prescribed. It was reported Resident # 1 (R1) was over medicated by being provided additional medications not prescribed. R1 was admitted to the facility on 11/18/23 and taken to the hospital on 11/25/23 for an altered mental state from being overmedicated. R1’s Physician Report dated 11/14/23 indicated R1 required assistance with medication management, which was being provided by the facility. A review of R1’s records indicated the medications provided to R1 were prescribed by the physician. Outside source interviews revealed that R1’s primary care physician was on leave and there was an on-call physician filling in. Continued on an LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 08-AS-20231130145142

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GROSSMONT GARDENS SENIOR LIVING	FACILITY NUMBER: 374604675
	VISIT DATE: 12/05/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The on-call physician provided the outdated medication list, which was signed and dated by the physician. A review of facility records reflected the medication list from the primary care physician’s office showed the medication list was current as of 11/14/23 and was signed by a physician on 11/17/23, indicating it was accurate.

The facility’s internal records reflected R1’s responsible party was notified that an eye drop brought into the facility with the other medications was not present on the medication list. The facility made the responsible party aware they cannot dispense the eye drop without an order. The facility was aware of medication protocols and provided medications that were present and prescribed. R1’s interview revealed they were provided with more medications than they usually take. Also, R1 confirmed their regular primary care physician was out on leave and the assistant provided them with an outdated list. R1’s physician’s office provided a current medication list dated 11/28/23, which reflected less medications. The facility followed R1’s physician’s orders on file and administered the medications as prescribed by the physician. The facility did not overmedicate R1, the medication orders were followed.

During the course of the investigation, interviews were conducted, and records were reviewed. Investigation revealed inconsistent statements and information obtained did not present a preponderance of evidence to support or corroborate the allegation. The allegation was deemed unsubstantiated. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Executive Director, Reginald Jones whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha Persaud	TELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2